Rogers Rebecca G, Jeppson Peter C
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico.
Obstet Gynecol. 2016 Sep;128(3):635-50. doi: 10.1097/AOG.0000000000001519.
Pelvic fistulae are an abnormal communication among the genitourinary tract, the gastrointestinal tract, and the vagina or perineum. Genital tract fistulae have been described in the medical literature for the past several thousand years. Advancements in both the diagnosis and treatment of vaginal fistulae have been obtained over the past century as surgical interventions have become safer and surgical techniques have improved. The most common cause of fistulae worldwide is obstructed labor. In developed countries, fistulae most commonly occur after benign gynecologic surgery, but obstructed labor, malignancy, radiation exposure, and inflammatory bowel disease can also cause fistulae. Fistulae significantly affect quality of life. Diagnostic studies and radiologic imaging can help aid the diagnosis, but a thorough physical examination is the most important component in the evaluation and diagnosis of a fistula. Temporizing treatments are available to help ease patient suffering until surgical management can be performed. Surgical repairs can be performed using an abdominal, vaginal, or transanal approach. Although technically challenging, surgical repair is usually successful, but closure of the fistula tract does not guarantee continence of urine or feces, because there is often underlying damage to the bowel and bladder.
盆腔瘘是泌尿生殖道、胃肠道与阴道或会阴之间的异常通道。在过去几千年的医学文献中已有关于生殖道瘘的描述。在过去的一个世纪里，随着手术干预变得更安全且手术技术得到改进，阴道瘘的诊断和治疗都取得了进展。全球范围内瘘最常见的原因是产程梗阻。在发达国家，瘘最常发生于良性妇科手术后，但产程梗阻、恶性肿瘤、辐射暴露及炎症性肠病也可导致瘘。瘘显著影响生活质量。诊断性检查和放射影像学有助于诊断，但全面的体格检查是瘘评估和诊断中最重要的部分。在能够进行手术治疗之前，可采用临时治疗措施来减轻患者痛苦。手术修复可通过腹部、阴道或经肛门途径进行。尽管手术修复技术上具有挑战性，但通常是成功的，不过瘘管闭合并不保证尿液或粪便的节制，因为肠道和膀胱往往存在潜在损伤。
